What Does Patrick Swayze Know About Fetal Arrhythmias? by Dr Alison Chu MD, Editorial Fellow, Neoreviews

What does Patrick Swayze know about fetal arrhythmias? by Dr Alison Chu MD, Editorial Fellow, NeoReviews

Figure 1. The 1987 romantic drama Dirty Dancing made for just $6 million, went on to gross $214 million worldwide and was the first film to sell over 1 million copies on video. Last week, I auscultated an adult for the first time since I graduated from medical school in 2007. It was awkward, and eerily reminiscent of that scene in the 1987 film " Dirty Dancing" where Patrick Swayze is trying to teach Jennifer Grey how to feel the rhythm of her heart beat (minus Jennifer's white Keds ® and Patrick's hair).

I was attending in the newborn nursery, and we were evaluating one of the neonates for an arrhythmia. When the mother had come in for a scheduled Cesarean section and they had placed the baby on monitors, they had detected an irregular tachycardic fetal heartbeat.

After delivery, and after lab work, an echocardiogram, an EKG, and 24-hour Holter monitoring, we had diagnosed the infant with a ventricular tachycardia.

We were preparing to discharge the infant home with a very scared set of parents, with instructions from the pediatric cardiology team to check the baby's heart rate twice a day. I was trying to teach the father how to auscultate and count the baby's heart rate, and as the infant's heartbeat was so irregular and fast, I thought it would be easier to teach the father first on his own heartbeat. The father and mother were scared and on the verge of tears, worried that if they couldn't figure out how to take their newborn son's heartbeat, the baby might be in serious life-threatening danger.

Fetal arrhythmias are scary for all parties involved - families, physicians and medical providers, alike. The fact that some arrhythmias do, in fact, put neonates at increased risk for sudden death, should be enough reason for perinatologists, neonatologists and pediatricians to take notice and re-educate themselves on how to diagnose and manage fetal arrhythmias through the perinatal period and beyond. Drs. Wacker-Gussmann, Wakai, and Strasburger provide an excellent review in their October NeoReviews article, "Complex Fetal Care: Importance of fetal Arrhythmias to the Neonatologist and Pediatrician" on just how much information about the fetus can be available prior to delivery, arming the perinatal care team with the ability to efficiently and competently care for a neonate with a prenatally detected fetal arrhythmia.

Included in the article is a description of fetal magnetocardiography, which is a newer method that is more

Copyright © 2016 American Academy of Pediatrics precise than echocardiography for detection of fetal arrhythmias and conduction abnormalities. While not yet widely available, its use has allowed for prenatal detection of unsuspected arrhythmias and led to modifications in the medical care of affected fetuses.

The article also i

Figure 2. Hollywood's version of heart auscultation. ncludes a practical review of common fetal arrhythmias, including long QT syndrome, AV conduction abnormalities, and supraventricular tachycardia. As if being a first-time parent isn't terrifying enough, I can't imagine taking home a baby with a brand-new diagnosis of arrhythmia. Perhaps if I had the skills of Patrick Swayze, it would have been much easier to teach the parents how to take a heart rate, and they wouldn't have felt so overwhelmed. However, I imagine that what may have actually made the parents feel better would've been the opportunity for earlier detection and a comprehensive prenatal evaluation.

These things would have potentially armed the medical team with more information and improved our ability to care for the patient and along the way, mitigate some of the fears of his family.